From risk scores to prevention action: the development of BEPU2025 to standardise and optimise pressure ulcer risk assessment and prevention in Belgium

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OBJECTIVE: Effective pressure ulcer (PU) prevention requires the timely identification of patients at risk and the prompt implementation of appropriate preventive interventions. However, many PU risk assessment instruments are complex, time-consuming and difficult to integrate into routine clinical workflows, potentially limiting their uptake in practice. METHOD: In Belgium, these challenges led to the initiation of the Belgian Pressure Ulcer Risk Assessment project in 2016, which aimed to develop a clinically feasible approach to PU risk assessment and prevention. Building on the experiences of the earlier local assessment tools BEPU2016 and UZL-RWD2017, BEPU2025 was developed as a nationally aligned pressure risk assessment and prevention approach that integrates risk assessment, daily reassessment and structured PU prevention pathways within routine care processes. RESULTS: Rather than generating numerical risk scores, BEPU2025 focuses on supporting prevention-oriented clinical decision-making through rapid and repeated assessment of risk. Developed through almost a decade of Belgian quality improvement initiatives, BEPU2025 combines a concise assessment framework with workflow integration, electronic patient record implementation and a strong emphasis on nurse-led prevention. CONCLUSION: This viewpoint argues for a shift from score-based risk assessment towards a dynamic, prevention-oriented approach embedded within routine care processes. Further research is needed to evaluate its impact on clinical outcomes and its applicability in other healthcare settings.